Who Gets Epilepsy Surgery?
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If you've been treated for epilepsy without much success or relief, you could be a candidate for epilepsy surgery. Find out the facts about who gets epilepsy surgery and why.
Transcript: Surgical therapy to treat seizures was developed in the 1800s! Yet, while epilepsy surgery has come a...
Surgical therapy to treat seizures was developed in the 1800s! Yet, while epilepsy surgery has come a long way since then, it is still not for everyone. Several types of surgeries can help to eliminate or reduce seizures in people with epilepsy. Brain surgery is an important decision, and is usually undertaken when multiple medication trials have failed to control seizures. The vast majority of people who are treated with epilepsy surgery have partial seizures. Surgery can be performed on children as well as infants under one year of age. Several factors are important in considering someone for possible epilepsy surgery. They include whether the patient has: seizures that are not controlled by systematic medication trials; localized seizure onset in the brain; a level of health that makes brain surgery relatively safe; and an understanding and acceptance of the risks. Generally, epilepsy surgery is considered for people who have seizures that cannot be controlled by anti-epilepsy drugs, because of ongoing seizures, unacceptable side effects, or both. This unfortunate situation - poorly controlled seizures - occurs in 1 out of every 3 people with epilepsy. For epilepsy surgery to be considered, seizures also need to be severe, or frequent enough, to impair quality of life, a standard that varies tremendously for different people. For some people, seizures that prevent them from being able to drive, or high doses of medications that cause continual side-effects, is reason enough to pursue possible surgery. Other people have daily seizures and side effects but still do not want to consider brain surgery. Most doctors will not perform surgery until a patient has had uncontrollable seizures for at least two years. Although when seizures are frequent or severe, it may be considered sooner. Typically, surgery is considered only if the patients seizures are unable to be controlled by at least two single drugs and one two-drug combination. It is critical that these medication trials are done systematically. Just one week on a drug is long enough to determine a bad side effect, like a rash, but is not an adequate trial of how well the medication works. A doctor gradually increases medication dosages to the maximum tolerable level, to see if greater doses will effectively control seizures. Once a patient is considered for surgery, tests are performed to identify what area of the brain is giving rise to seizures. This is because some areas of the brain can be removed without changing intellect or personality. But removal of other brain areas can cause problems with language, memory, sensation, strength and other functions. In some cases, the risks of surgery outweigh the benefits, while in others, the chances for seizure control are good, with limited risk to vital brain functions. The decision to have surgery involves careful, individualized consideration by both patient and doctor. Remember, epilepsy surgery is elective, and should ultimately, be the patients decision. If you think you may be a candidate for surgical therapy for epilepsy, talk to your physician about a referral to an epilepsy center.More »
Last Modified: 2013-06-06 | Tags »
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A complete check-up is essential before you undergo surgery for diseases like epilepsy. Watch the video on pre-surgical assessment #1 to find out more.
Transcript: Epilepsy surgery is not for everyone! So how is a patient considered and assessed for a surgical procedure?...
Epilepsy surgery is not for everyone! So how is a patient considered and assessed for a surgical procedure? Before a person can even be considered for surgery, his or her seizures must persist despite medications and must also interfere with the patient's quality of life. In addition, the surgical candidate must be healthy enough for a brain operation, and be willing to accept the risks of surgery. If these criteria are met, a pre-surgical evaluation is conducted to try and find the area where seizures start, called the seizure focus. The best candidates are those in whom a single, relatively small seizure focus is found in a part of the brain that can be safely removed. The first part of pre-surgical assessment is a careful description of seizures by the patient. This can give clues about the location in the brain where seizures arise. Next, an EEG, or electroencephalogram, is conducted to measure brain waves, in turn helping to localize abnormal electrical activity in the brain. While EEGs taken between seizures can help, recordings during a seizure are most informative. This procedure is usually completed in a video EEG monitoring unit, where patients stay for several days or longer to record EEG and video during seizures. If three or more seizures show a consistent place of origin, surgery will likely be successful! Neuro-imaging with an MRI is another important test for localizing a seizure focus, because it may show a scar or brain injury that is causing the seizures. When both the EEG seizure focus and an MRI abnormality are in the same region, confidence regarding the very best surgical target is increased. Another vital assessment is neuropsychological testing. Pencil and paper tests are given to measure the person's skill in memory, language and other thinking tasks. A. In most right-handed people, the left side of the brain controls language and calculations, B. while the right side controls picture memory and spatial perception. Specific thinking problems shown during neuropsychological testing can help identify abnormal function in different brain areas. Video EEGs, MRIs, and neuropsychological tests are completed in all candidates being seriously considered for epilepsy surgery. Several other tests are done on an individualized basis. One such test, a PET scan, is an imaging test that uses a radioactive tracer to measure consumption of glucose in the brain. This is useful because the seizure focus may consume less glucose between seizures than normal areas of the brain. PET scans are often used when a patient's MRI does not show a clearly abnormal region giving rise to seizures. Another test that measures brain activity, and may be used, is called magnet-oencephalography, or MEG. This can provide a 3-dimensional map of where epilepsy waves come from. If these tests suggest that surgery can help control seizures, the doctor may recommend additional tests that are more invasive. These additional tests allow direct stimulation of different parts of the brain, which can help pinpoint seizure focus and localize normal functions further. To learn more about these tests and how they are administered, please see the next video in this series.More »
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Before you opt to have a surgery for any disease like epilepsy it is very important to have a thorough check-up. Check out the video on pre-surgical assessment to learn more.
Transcript: Before a patient undergoes surgery to treat epilepsy, pre-surgical tests-which may be invasive-are vital...
Before a patient undergoes surgery to treat epilepsy, pre-surgical tests-which may be invasive-are vital to assess where in the brain seizures start. All surgical candidates must undergo several non-invasive tests, described in the prior video, during their pre-surgical assessment to find the area where seizures start, called the seizure focus. If these tests suggest that surgery is likely to help control seizures, the doctor often recommends additional tests that are more invasive and do come with some risk.A commonly used invasive test is the intracarotid hemispheric dominance, or Wada, test. It involves a catheterization, in which a thin plastic tube is put into an artery where the upper thigh and pelvis meet. anesthetic is injected. This is performed sequentially on both sides, putting the left and right sides of the brain to sleep, in turn allowing speech and memory to be tested. In most people, language is on the left side of the brain and memory is on both sides. However, if memory is impaired on one side, then it suggests that the temporal lobe on that side is not working well and may be the source of seizures. The Wada test helps a neurosurgeon plan safe boundaries for epilepsy surgery. For example, if memory is impaired in the right half of the brain but excellent on the left side, a right temporal lobectomy can likely be done without risk of harming memory. Meanwhile, because some seizures originate deep in the brain, their onset is not always seen clearly by scalp EEG recordings. In these cases, electrodes are placed under the skull to help a doctor get a close-up look at the seizure focus. Two different kinds of electrodes are used, A. subdural electrode grids, or strips, which are put under the skull on top of the brain, B. and depth electrodes which go directly into the brain tissue. The grid electrodes placed on the surface of the brain can get a close-up recording of seizures. These grid electrodes can help map the functions, such as language or movement, of the underlying region of brain. This is done by sending a small electrical current through an electrode, which can inactivate a part of the brain for a few seconds. If an activity, like counting to ten for example, is interrupted by this, then the part of the brain which was stimulated can be marked as a control area for speech. Similar analysis can be applied to movement, reading, or other brain functions. Grid mapping is useful when seizures are close to a critically important region of the brain. Subdural or depth electrodes can be used in surgical procedures intended only to diagnose seizure focus, but they can also be used as part of a two-stage epilepsy surgery. In the latter case, the first stage involves recording the seizures and possibly mapping them... while the second stage involves removing the electrodes, followed by the removal of the brain tissue from where the seizures arise. If these tests show a person to be a good surgical candidate, then he should engage in discussion about the risks and benefits of the recommended procedure with an epilepsy team.More »
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When epileptic seizures can't be controlled, resective surgery is sometimes performed to remove part of the brain that produces the seizure. Learn more about the procedure in this video.
Transcript: Resective surgery is the most common form of surgical treatment for uncontrolled seizures. So what is...
Resective surgery is the most common form of surgical treatment for uncontrolled seizures. So what is resective surgery? Resective surgery is a type of epilepsy operation in which the area of the brain responsible for seizures is surgically removed. The brain is comprised of four lobes called the frontal, temporal, parietal, and occipital lobes. Seizures most often arise from one or both temporal lobes. In the deep front part of the temporal lobes are located the most seizure-prone structures in the brain: The hippocampus, which is Greek for "seahorse," and the amygdala, which means "almond." Because of this, temporal lobectomy is the most common- most successful-type of resective surgery. Access to the deep temporal lobe can be achieved in two ways. The conventional approach involves removing an inch and a half from the tip of the temporal lobe to provide access. The second involves cutting into the outer brain and opening a window from the side. However it is accessed, the hippocampus, amygdala and surrounding brain are removed by a combination of cutting and suction, since brain tissue is soft. All bleeding is carefully controlled during surgery. The surgery does not remove a tiny piece of brain, but rather a sizable part of one lobe. After the removal of the temporal lobe tissue is complete, the bone is replaced and secured to the skull, and the scalp is sutured. Whenever possible, the surgeon uses incisions behind the hair line for the best possible cosmetic results. Patients then move to a recovery room or intensive care unit. A few days post-surgery, though, most move to a normal room and are eating and walking. Post-operative nausea and headache are common, so patients receive medicines for these conditions-and possibly seizure medications as well-intravenously for six to 48 hours. Hospitalization for temporal lobectomy typically lasts from four to six days for a one-stage surgery, and nine to 14 days if a two-stage surgery is completed. Then, patients take it easy around the house for a week, at which point the surgical stitches or staples are removed. Vigorous activity should be avoided for a month or two, but a patient can generally return to work within one to three months. Patients often ask whether the part of the brain which is removed ever grows back. It does not. Immediately following surgery, the fluid that surrounds the brain fills in the empty area. Another common question is whether the surgery creates a scar that will produce seizures. Usually it does not, because the surgical scar is "clean" and does not irritate adjacent parts of the brain. This is like the difference between a plastic surgery scar and a scar from a bad accident. When a patient has undergone resective surgery, most doctors will keep that patient on seizure medicines for at least several years. Sometimes, medication is necessary for life, although the dosage might be reduced. While resective surgery can be quite effective, it is not for everyone and is always a patient's personal choice! If you think you might be a good candidate for surgery, discuss your options with your doctor.More »
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Before you decide on having surgery for your epilepsy, it is important that you understand the risks and benefits. To learn more on the subject watch this video.
Transcript: Before an elective surgery, a patient and doctor must compare the risks and benefits of the operation...
Before an elective surgery, a patient and doctor must compare the risks and benefits of the operation itself to those of ongoing seizures. While surgery has risks, seizures and high doses of medications have risks as well. Epilepsy surgery is a time and money commitment. Although surgery is usually covered by health insurance, the cost still is high: From $40,000 to over $100,000! Misperceptions and misunderstandings about surgery are common. While it is vital to have an accurate picture of potential complications, it is also important to eradicate unfounded fears. Similarly, it is critical to have realistic expectations. Many patients worry that removing a portion of the brain will change their personalities, or "who they are," but this is very rarely the case. For most people with uncontrolled epilepsy, the area of the brain that causes seizures is not functioning properly anyway. Since it's not doing what it should be doing, removing it is usually safe. Furthermore, the electrical activity arising in the brain's seizure focus often impairs the functioning of other brain areas. The medical team needs to help the patient and their family understand the risks and benefits of the surgical procedure in context with the risks of uncontrolled seizures or high doses of anti-epilepsy medications. For example, for people with severe or frequent seizures, epilepsy may be progressive and debilitating, with memory and mood problems that worsen with time. Plus, very high doses of medications can adversely affect health. Together, seizures and medication side effects can impair quality of life, including the ability to drive, work, and learn. Of course, the worst complication after any epilepsy surgery is death, which occurs in less than one out of 1,000 cases. But remember that uncontrolled epilepsy can also be deadly! Among people whose seizures are severe enough to be surgical candidates, up to nine percent run the risk of dying from sudden unexplained death syndrome, or SUDEP, over a ten year period. What are the benefits of epilepsy surgery? Depending on the particular type of surgery, more than 60 percent of patients can become seizure free, and 90 percent can enjoy a significant reduction in their seizure activity. Many patients report that in addition to experiencing fewer seizuresthey have an improved quality of life due to reduced depression, and reduced medication burden. These general considerations apply to anyone considering epilepsy surgery, but each particular type of surgery has its own risks, benefits, and success rates that vary by the individual case. To learn more about specific surgeries, please watch the next video in this series.More »
Last Modified: 2014-06-10 | Tags »
elective surgery, seizure surgery, epilepsy surgery, brain surgery, brain surgery risks, surgery complications, seizure surgery misconceptions, seizure focus, quality of life, brain surgery considerations, surgery cost, insurance coverage for surgery ongoing seizures, time, money, health insurance, brain activity, electrical brain activity, brain function, impaired brain function conditions, epilepsy, neurological disorders
Before undergoing procedures for diseases like epilepsy you need to first understand everything about it. Watch this to learn about the risks and benefits of surgery.
Transcript: Each year, more than 2,000 people get surgery to control or reduce their epileptic seizures. Some of...
Each year, more than 2,000 people get surgery to control or reduce their epileptic seizures. Some of these surgeries are riskier than others. While there are differences between the types of epilepsy surgery which are performed, many of the same considerations apply to all of them. When a doctor presents epilepsy surgery as an option, it is important that he or she place the risks and benefits of the procedure in context with the risks of uncontrolled seizures or high doses of anti-epilepsy medications. There are many types of surgery - and each is associated with different risks and benefits. The most common type of epilepsy surgery is called a temporal lobectomy. This is the removal of part of one of the temporal lobes in the brain... areas associated with memory and emotion. Following a temporal lobectomy, there may be a slight decline in memory and word-finding, especially for rarely used words. These potential problems are most likely to occur if the operation is performed on the left temporal lobe, which controls language functions. After a temporal lobectomy, the most common emotional changes are improvements in anxiety and depression. However, anxiety or depression can occasionally develop for the first time after a lobectomy. If it does, it is usually temporary and responds well to medication. Although some patients experience a minor loss of vision on the side opposite from the surgery, it is usually so slight that most are unaware of it! The most serious risks of temporal lobectomy are a 1 to 2 percent chance of stroke, and a 0.1 percent risk of death. However, because epilepsy surgery is elective and allows for preparation, the risks are reduced to the lowest possible levels in neurosurgery. After a temporal lobectomy, 55 to 75 percent of patients are free of seizures that impair consciousness. An additional 10 to 30 percent have occasional seizures, but enjoy a significant reduction in seizure activity. Unfortunately, occasional seizures that impair consciousness will still restrict driving and certain other activities. However, up to 15 percent of patients notice no improvement post-surgery. Most people who become seizure-free after surgery still require anti-epilepsy medications, but often in lower doses than before. Some patients can eventually come off all medications, but this is not the primary goal. Seizure freedom at medication doses that are well tolerated is considered success. A lesionectomy is another type of epilepsy surgery. Lesionectomy and other epilepsy surgeries that remove brain tissue generally come with a risk of stroke that is just 1 to 2 percent. Depending on the specific location of the seizure focus, there may be other risks to vital brain functions including language, movement, or sensation. Corups callosotomy, another form of surgery, carries a slightly higher risk of stroke or of problems with attention or behavior. The corpus callosum is the largest group of fibers, or wires, that connect the left and right sides of the brain. After a partial corpus callosotomy-which severs the front two-thirds of this fiber bundle-seizure reduction is around 60 to 80 percent for certain seizure types, including tonic-clonic, atonic and tonic seizures. After the complete procedure-which often involves two separate surgeries-reductions rise to 80 to 90 percent. Another surgery, called hemispherectomy, is the removal and/or disconnection of half the brain. Although the functions of this half of the brain are often seriously impaired before surgery, any remaining functions are lost after the procedure. However, hemispherectomy does provide almost complete seizure relief in over 75 percent of patients! When deciding if epilepsy surgery is right for you, it can often be helpful to obtain the opinion of experts at another epilepsy center, or to speak with patients who have had surgery before. Bottom line, if someone is a good candidate for surgery and epilepsy significantly impairs quality of life, surgery is worth seriously considering!More »
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Through different types of epilepsy surgery procedures you can reduce the frequency of seizures. Learn more about epilepsy surgery here in this video.
Transcript: In a resective surgery, a portion of the brain is removed. When this is not possible, doctors may consider...
In a resective surgery, a portion of the brain is removed. When this is not possible, doctors may consider other forms of brain surgery to treat epilepsy. While resective surgery is the most common type of epilepsy surgery, there are several others which can be useful. One such procedure is called a "lesionectomy." A lesion is an abnormal structure in the brain, like an old scar. The scar may be present due to past trauma, bleeding, infection, stroke, abnormal blood vessels, a birth defect, or a tumor. A. Seizures often originate around a lesion,B. so a lesionectomy removes it, C. as well as a rim of surrounding brain tissue believed to be involved in seizures. Another type of procedure, called disconnection surgery, involves severing specific nerve pathways in the brain along which seizures spread. One disconnection surgery - which reduces atonic, tonic-clonic, and tonic seizures - is corpus callosotomy. During this procedure, the corpus callosum-which is the large fiber bundle in the brain that connects the two hemispheres-is cut. Often, the operation involves severing just the front two-thirds of this area. Following this partial procedure, seizure reduction hovers around 75 percent. Later, a second operation may be performed to disconnect the remaining third of the corpus callosum, reducing rates of some seizures by up to 85 percent. The most dramatic surgery performed to treat epilepsy is hemispherectomy. This operation involves removing and or disconnecting one cerebral hemisphere from the rest of the brain. Hemispherectomy is usually only considered in patients with severe seizures who also have some weakness and sensory loss on the side of the body opposite from surgery. This is because the surgery will cause severe weakness and sensory loss, even if it is not there already. Another rare form of epilepsy surgery is a multiple subpial transection procedure. This operation is used to control seizures that stem from areas of the brain which cannot safely be removed. For example, if seizures originate in an area that is critical for language, removing this area might devastate the understanding of language or speech. A subpial transection involves making multiple superficial cuts into the more shallow layers of the brain. A. These cuts, or transections, B. interrupt fibers that connect neighboring parts of the brain, C. in turn disrupting the spread of seizure activity. This procedure is not as effective as removal or disconnection surgery and only a minority of patients become entirely seizure free after this procedure. Still, major complications of a subpial transection are rare, and the benefits can outweigh potential complications. No matter the form of epilepsy surgery considered, however, surgery is not for everyone and is always a patient's choice. If your seizures are not being controlled, discuss the possibility of epilepsy surgery with your medical team.More »
Last Modified: 2013-06-07 | Tags »
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Do you know PNES are dictated by psychological events which a patient cannot control? Treating PNES requires accurate diagnosis. Check out our video to know more.
Transcript: Certain psychological conditions can cause psychogenic non-epileptic seizures, which are episodes that...
Certain psychological conditions can cause psychogenic non-epileptic seizures, which are episodes that imitate seizures. Psychogenic non-epileptic seizures, or PNESs, are complicated because-while they look like seizures-PNESs do not result from abnormal electrical discharge in the brain. Instead, they are dictated by psychological events which a patient cannot control. Effectively diagnosing PNESs begins with a physician considering the possibility that a person's seizure-like events may not be epileptic seizures. By listening to a careful description of the events, or looking at a home video of an episode, an experienced doctor can tell whether an attack has the characteristics of an epileptic seizure. But even experienced epilepsy specialists can be fooled by descriptions alone. An accurate diagnosis can often be made by recording the episode with videoand an EEG in an Epilepsy Monitoring Unit. In cases where the patient's history is unclear and an event cannot be observed or recorded, then the diagnosis may remain uncertain. Once a diagnosis of PNESs is made, treatment is very specialized, and ideally, should involve a partnership between a psychiatrist, a neurologist, and the patient's primary care physician. However, not all psychiatrists and neurologists are familiar with psychogenic non-epileptic seizures. You can find physicians who are by contacting an Epilepsy Center at a university medical school near you. Once a patient finds the right medical treatment team, the treatment must be individualized, because everyone is unique. Psychotherapy can be useful to help a patient explore, understand and manage the stressors that led to PNESs. People also can train themselves to use relaxation exercises and mental imagery at the start of their events, in order to make them less intense. Treating PNESs is often complicated because many patients with the condition are given heavy doses of anti-epileptic medications. In the absence of epileptic seizures, these medications just produce side effects and make life even more difficult. Of course, remember that you should never stop taking medication on your own. Work with your physician, because sudden withdrawal can be dangerous! If someone in your family experiences PNESs, try to keep calm, be quietly reassuring, and remember that a psychogenic non-epileptic seizure does not harm the brain If there is thrashing or physical activity, you should protect from injury. But if your presence seems to prolong the attack, it may be best to leave the person alone. In the long-term, you can help by encouraging participation in psychiatric care and their relaxation exercises. A person having ongoing PNE is generally not safe to drive. After the episodes are controlled, this can change, although caution is needed! The good news is that more than half of the people who experience psychogenic non-epileptic seizures can become episode-free! However, this prognosis depends upon the patient's motivation, how severe the underlying psychological or physical disorders are, and whether good medical help can be obtained. If you or someone close to you is having either epileptic or psychogenic non-epileptic seizures, please contact a physician.More »
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You are not alone if you confuse PNES, or psychogenic non-epileptic seizures, with epileptic seizures. Understanding PNES is important in order to accurately treat this condition. Check out our video to learn more.
Transcript: While many conditions can imitate seizures, one of the most serious is called PNES or, psychogenic non-epileptic...
While many conditions can imitate seizures, one of the most serious is called PNES or, psychogenic non-epileptic seizures. A PNES is a seizure-like event that is produced-not by abnormal electrical charges in the brain-but by psychological factors of which the patient is not fully aware and cannot control. Psychogenic non-epileptic seizures go by many names, including pseudoseizures, psychological seizures, psychosomatic seizures, and psychogenic seizures, but doctors commonly call them non-epileptic seizures. Because thoughts and feelings have an impact on our physical being, unresolved stressors often manifest as physical symptoms, be they headaches, ulcers, skin rashes, or shaking and blackouts that look like seizures. Sometimes the stressors that lead to a PNES involve extreme pressure to succeed in an area of one's life. Other times, stressors are forms of mental, physical or sexual abuse. These traumas can remain from years past, even dating back to childhood. The unconscious brain does not treat time in the same way that the conscious brain does, and old psychological issues can live on. They are even more potent if something happens today to bring back the feelings of yesterday! Therefore, a psychogenic non-epileptic seizure may result from unresolved stress and psychological tension, often dating back years! It's important to note though, that people with epileptic seizures list stress as one of the most common provoking factors. This means that having an event that is provoked by stress does not necessarily mean that a person is having a PNES. Family and friends of people with psychogenic non-epileptic seizures should realize that the person having the problem is not "faking" or putting it on intentionally, but that it is an involuntary medical condition! People with PNES are a very mixed group. Some have mental disorders such as depression, adjustment disorders, personality disorders, or rarely, even psychotic disorders. Then again, some people with PNES have no obvious underlying mental problems whatsoever. That's why everyone needs to be evaluated and treated individually. During a psychogenic non-epileptic event, the brain's electrical activity, which is shown by its EEG pattern, remains normal. This point can be confusing, because an EEG occasionally can be normal during epileptic seizures, as well. Also remember that the EEG is often normal between seizures in people who do have epilepsy. On occasion, a person can have both non-epileptic and epileptic seizures, making diagnosis even more difficult! To those who have them or see them in a loved one, non-epileptic seizures are as real as epileptic seizures. Any seizure-like event requires appropriate diagnosis and medical care!More »
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The right kind of treatment is super important when you've been diagnosed with epilepsy. Learn more about what to look for when choosing a seizure medication.
Transcript: Medications are the main treatment for epilepsy and there are over 20 choices! These medicines are called...
Medications are the main treatment for epilepsy and there are over 20 choices! These medicines are called antiepileptic drugs, or AEDs, but this is actually a misnomer, because these medications do not prevent or cure epilepsy. Instead, AEDs work to suppress seizures. There are five principles of AED therapy that many doctors follow. When a patient has seizures, the first consideration is whether to treat them with AED therapy. Certain types of seizures, like simple partial seizures with only minor sensory, motor, or mental manifestations, might not require treatment. Also, a first seizure may not require treatment if tests show no factors likely to produce subsequent seizures. If the decision is made to treat, the next step is to choose the best medication for a particular patient's seizures. There are no hard-and-fast rules for selecting seizure medicines, because most AEDs work for several different types of seizures. Many factors are considered, including side effects, risk of a serious reaction, convenience of administration, and cost. After a medication is selected, a doctor will then decide the best AED therapy regimen, which generally requires usage on a simple schedule. A regimen of one drug, called monotherapy, is less likely to produce side effects and drug interactions than using multiple AEDs. Moreover, studies show that additional drugs rarely eliminate seizures when one drug in full dose does not. Although more than one drug is sometimes necessary, a simple dosing schedule is most likely to be followed correctly. It's important to take AEDs on a reliable schedule, because skipping medicine can result in a seizure. Side effects are another consideration. Every medication, even aspirin, has potential side effects. Seizure medicines have many, because they act on both body and brain. Most seizure medicines make brain cells fire less rapidly. This is useful to control a seizure, where brain cells fire at exceptionally high rates. But brain cells also fire quickly during some normal activities, such as maintaining balance, focusing eyes, and thinking. All of these activities are slower and less precise with seizure medicines in the brain, which is why significant effort is devoted to balancing seizures and side effects. All too often, patients experience both seizures and side effects. When this occurs, a different strategy is needed - like a different medicine, fewer medications, or non-medication therapies. Switching medications can be difficult. A doctor can help keep the process on track by providing a written dose-initiation schedule. Patients should expect a temporary period of increased side effects and possible withdrawal seizures during any medication change. Finally, AED therapy is not always forever. Tapering AEDs can be considered when a patient has been seizure-free for at least two years. However, AED therapy can only be stopped once it has been established that the patient has no major ongoing predisposition to seizures...and has no seizure activity on a routine EEG. The patient should also not have experienced problems with prior attempts to stop medicines. Even if seizures have not occurred for years, medications usually are continued if... an underlying problem in the brain is present, like a stroke, tumor, abnormal blood vessel, or birth defect. If someone meets the conditions for tapering, there is a two-in-three chance of being able to withdraw AEDs successfully. The flip side is that there is a one-in-three chance of having a seizure after withdrawing medicine-a risk that some find unacceptably high. Also, many doctors advise not driving while withdrawing AEDs, which prevents some patients from even trying. In all cases, except emergencies, medications are tapered slowly and under the care of a doctor! The goal of medication therapy is not only seizure control, but also improvement in quality of life. If side effects, inconvenience, or cost make the treatment worse than the disease, do not hesitate to explore other options with your medical team.More »
Last Modified: 2014-06-11 | Tags »
antiepileptic drugs, AED, antiseizure medications, seizure medications, types of seziure medications, seizure medicine side effects, seizure treatment, monotherapy, non medication therapy brain function, confusion, slowed thinking, tapering medications conditions, epilepsy, neurological disorders
If you have a severe case of epilepsy, it may be possible for you to have surgery. Watch this video to learn if you are a good candidate for epilepsy surgery.
Transcript: Several factors are important in considering someone for possible epilepsy surgery. They include whether...
Several factors are important in considering someone for possible epilepsy surgery. They include whether the patient has: seizures that are not controlled by systematic medication trials; localized seizure onset in the brain; a level of health that makes brain surgery relatively safe; and an understanding and acceptance of the risks. Generally, epilepsy surgery is considered for people who have seizures that cannot be controlled by anti-epilepsy drugs, because of ongoing seizures, unacceptable side effects, or both. This unfortunate situation - poorly controlled seizures - occurs in 1 out of every 3 people with epilepsy. For epilepsy surgery to be considered, seizures also need to be severe, or frequent enough, to impair quality of life, a standard that varies tremendously for different people. For some people, seizures that prevent them from being able to drive, or high doses of medications that cause continual side-effects, is reason enough to pursue possible surgery.More »
Last Modified: 2014-06-30 | Tags »
epilepsy, epilepsy surgery, am i a good epilepsy surgery candidate, brain suregry, systematic medication trials, epilepsy surgery risks seizures, anti-seizure medications, anti-epilepsy drugs conditions, quick tips, epilepsy
One method to control seizures is the temporal lobotomy procedure.Watch this video to learn how it's done.
Transcript: Access to the deep temporal lobe can be achieved in two ways. The conventional approach involves removing...
Access to the deep temporal lobe can be achieved in two ways. The conventional approach involves removing an inch and a half from the tip of the temporal lobe to provide access. The second involves cutting into the outer brain and opening a window from the side. However it is accessed, the hippocampus, amygdala and surrounding brain are removed by a combination of cutting and suction, since brain tissue is soft. All bleeding is carefully controlled during surgery. The surgery does not remove a tiny piece of brain, but rather a sizable part of one lobe. After the removal of the temporal lobe tissue is complete, the bone is replaced and secured to the skull, and the scalp is sutured. Whenever possible, the surgeon uses incisions behind the hair line for the best possible cosmetic results. Patients then move to a recovery room or intensive care unit. A few days post-surgery, though, most move to a normal room and are eating and walking.More »
Last Modified: 2014-06-30 | Tags »
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